Spinal dural arteriovenous fistulas (SDAVFs) are abnormal connections between 1 or more radiculomeningeal arteries and a single radiculomedullary vein draining into the perimedullary venous system. SDAVFs present in older patients with a progressive myelopathy caused by diffuse spinal venous hypertension. The discrepancy between the focal nature of the arteriovenous shunt and the extent of the induced myelopathy is a classic feature of SDAVFs related to the coexistence of diffuse spinal venous drainage impairment.
We describe 3 cases of cervical SDAVFs (at C1, C4, and C7) presenting with a myelopathy that spared the cervical spinal cord and, in 2 instances, the upper thoracic cord. This is to our knowledge the first observations of cervical SDAVFs with MRI showing absent or subtle flow voids and presenting remote thoracolumbar myelopathy without cervical cord involvement.
A considerable distance may separate low-flow spinal arteriovenous fistulas from the spinal cord damage they produce. These observations emphasize the importance of performing a complete spinal angiogram when investigating a vascular myelopathy of any location and extent.
A considerable distance may separate low-flow spinal arteriovenous fistulas from the spinal cord damage they produce. These observations emphasize the importance of performing a complete spinal angiogram when investigating a vascular myelopathy of any location and extent.Studies that have analyzed the association between cannabis use and acute ischemic stroke (AIS) have provided conflicting results. In this study, we aim to determine the association of recent cannabis use detected through urine drug screen (UDS) among patients admitted with AIS.
A retrospective observational study was performed using the medical records database. All patients aged 18 years and older admitted from January 1, 2015, to December 31, 2017, who underwent urine toxicology testing on admission were included in the analysis. Multivariate logistic regression analysis was performed to analyze independent association between recent cannabis use and AIS.
A total of 9,350 patients were determined to have undergone UDS during admission, and 18% (1,643) of this had a positive urine cannabis test. Unadjusted risk ratio showed a 50% decrease in risk of AIS among cannabis users (risk ratio = 0.505, 95% confidence interval [CI] 0.425-0.600). The effect was lost after adjusting for age, race, ethnicity, sicconducted.Orthostatic tremor (OT) is a high-frequency weight-bearing tremor of the legs and trunk associated with progressive disability and is often refractory to medications. Case reports suggest that thalamic deep brain stimulation (DBS) is effective. We report 5 female patients with medication-refractory OT who underwent bilateral thalamic DBS at the Mayo Clinic and assess factors associated with a successful DBS outcome.
Demographic, clinical, electrophysiology, and DBS data were abstracted. https://www.selleckchem.com/products/ly3522348.html Outcomes were change in tremor-onset latency, standing time, standing ADLs, and patient and clinician global impression of change (PGIC; CGIC).
All 5 patients had improved standing time (72 vs 408 seconds, ? 0.001) and improved standing ADLs after surgery, without change in tremor-onset latency (16 vs 75 seconds, = 0.14). Maximal benefit was reached up to 3 years after surgery and sustained for up to 6 years. CGIC was "much improved" in all; PGIC was "much improved" in 4 and "minimally improved" in 1. There were noudies.To provide a review of cognitive outcomes across a full neuropsychological profile in patients who underwent laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE).
We examined cognitive outcomes following LiTT for mTLE by reviewing a consecutive series of 26 patients who underwent dominant or nondominant hemisphere procedures. Each patient's pre- and postsurgical performance was examined for clinically significant change (&gt;1SD improvement or decline on standardized scores), with a neuropsychologic battery that included measures of language, memory, executive functioning, and processing speed.
Presurgical performance was largely consistent with previous research, where patients suffering from dominant hemisphere epilepsies demonstrated deficits in verbal learning and memory, whereas patients with nondominant hemisphere scored lower on visually mediated tests. Case-by-case review comparing presurgical to postsurgical scores revealed clinically significant improvement in both domines (ATLs), where postsurgical decline has been documented in up to 40%-60% of cases, our LiTT case series exhibited a much lower incidence of postoperative language or verbal memory decline. Moreover, promising rates of postoperative improvements were also observed across multiple cognitive domains. Future studies exploring cognitive outcomes following LiTT should include comprehensive neuropsychological findings, rather than only select domains, as clinically significant change can occur in areas other than those typically associated with mesiotemporal structures.Approximately 400,000 diagnostic lumbar punctures (LPs) are performed by neurologists yearly in the United States. There has been a transition from neurologists performing &gt;40% of LPs 2 decades ago to now &lt;15% of the time. High body mass index (BMI) is one of the key obstacles of LP for neurology residents, and the success rates drop to 58% when BMI is &gt;35 kg/m.
A prospective intervention study was conducted from March 2017 to March 2018 at an academic medical center. Patients were divided into ultrasound-guided LP or conventional LP. The primary outcome was the success rate of LP. The secondary outcome was the parameters regarding LP performance, the patients' feedback after procedures, and the residents' feedback about the learning modules.
Eighty-two patients were enrolled with inclusion criteria of age &gt;18 years, BMI ?25 kg/m, and able to give written informed consent. The ultrasound-guided LP group showed higher success rate (92.7% vs 68.3%, &lt; 0.05) and less duration of time (17.02 vs 37.63 minutes, &lt; 0.05) compared with the conventional LP group. It also showed advantages of decreased trials of needle insertions and redirections and reduced pain levels perceived by patients.
This study suggests that using ultrasound to localize before LP could increase the LP success rate and improve other related LP outcomes in the overweight populations. Our study also provides evidence that brief, targeted teaching modules are feasible and effective for ultrasound-guided LP training.
This study provides Class III evidence that for patients with BMI ?25 kg/mundergoing LP, ultrasound guidance increases the LP success rate.
This study provides Class III evidence that for patients with BMI ?25 kg/m2 undergoing LP, ultrasound guidance increases the LP success rate.